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Cited by 572Innovations in Medical EducationStudent Assessment and FeedbackClinical Reasoning and Diagnostic Skills

The “educational alliance” as a framework for reconceptualizing feedback in medical education.

Telio, Summer, Ajjawi, Rola, Regehr, Glenn·2015·Academic Medicine
DOI 10.1097/acm.0000000000000560
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Abstract

Feedback has long been considered a vital component of training in the health professions. Nonetheless, it remains difficult to enact the feedback process effectively. In part, this may be because, historically, feedback has been framed in the medical education literature as a unidirectional content-delivery process with a focus on ensuring the learner's acceptance of the content. Thus, proposed solutions have been organized around mechanistic, educator-driven, and behavior-based best practices. Recently, some authors have begun to highlight the role of context and relationship in the feedback process, but no theoretical frameworks have yet been suggested for understanding or exploring this relational construction of feedback in medical education. The psychotherapeutic concept of the "therapeutic alliance" may be valuable in this regard.In this article, the authors propose that by reorganizing constructions of feedback around an "educational alliance" framework, medical educators may be able to develop a more meaningful understanding of the context-and, in particular, the relationship-in which feedback functions. Use of this framework may also help to reorient discussions of the feedback process from effective delivery and acceptance to negotiation in the environment of a supportive educational relationship.To explore and elaborate these issues and ideas, the authors review the medical education literature to excavate historical and evolving constructions of feedback in the field, review the origins of the therapeutic alliance and its demonstrated utility for psychotherapy practice, and consider implications regarding learners' perceptions of the supervisory relationship as a significant influence on feedback acceptance in medical education settings.

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  • Invested, credible supervisors and a supportive, open culture are integral to positive learning and coaching in medicine and education.

    “Invested, credible supervisors 2,4-7 and a supportive, open culture [33][34][35][36] are integral to positive learning and coaching in medicine 8 and education.16,19”

    From The R2C2 Model in Residency Education: How Does It Foster Coaching and Promote Feedback Use? (2018) · cites this paper as [5]

  • Context, including the relational element of feedback, is increasingly recognized as influential.

    “And context, including the relational element of feedback, is increasingly recognized as influential; Telio [51] has recently highlighted the contextual influence of the ‘educational alliance’ that develops between teacher and learner on the feedback that is exchanged.”

    From Guidelines: The do’s, don’ts and don’t knows of feedback for clinical education. (2015) · cites this paper as [51]

  • The concept of the 'educational alliance' has been proposed as a framework for understanding the links between the teacher-learner relationship and the impact of the feedback generated within it.

    “Recognizing the centrality of relationship in the feedback process, the concept of the ‘educational alliance’ has been proposed as a framework for understanding the links between the teacher-learner relationship and the impact of the feedback generated within it [51, 79].”

    From Guidelines: The do’s, don’ts and don’t knows of feedback for clinical education. (2015) · cites this paper as [51]

  • Reconceptualizing feedback as a two-way conversation has led to a greater emphasis on the learner's active participation in receiving and acting upon feedback.

    “Reconceptualizing feedback as a two-way conversation has led to a greater emphasis on the learner's active participation in receiving and acting upon feedback. 27-30”

    From Medical student perceptions of feedback and feedback behaviors within the context of the “educational alliance.” (2017) · cites this paper as [30]

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Authors
Telio, S., Ajjawi, R., & Regehr, G.
Affiliations
University of British Columbia (CA)
Corresponding author
Telio, Summer
ORCID
Venue
Academic Medicine
Publisher
Oxford University Press (OUP)
Published
2015-05
Volume
90
Issue
5
Pages
609-614
ISSN
1040-2446 (ISSN-L)
DOI
10.1097/acm.0000000000000560
OpenAlex
W2314955644
Semantic Scholar
6148f2ce9f470ff41cab8d0b9329c3d8292fe4dd
Cited by
572
References
61
Citations by year
2026: 62 · 2025: 43 · 2024: 67 · 2023: 67 · 2022: 59 · 2021: 65 · 2020: 51 · 2019: 50 · 2018: 48 · 2017: 28 · 2016: 23 · 2015: 8 · 2014: 1
FWCI
3.15
Type
journal article
Language
en
Open access
closed
Locations
  • Academic Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Discovery Research Portal (University of Dundee) (publishedVersion)
  • Deakin Research Online (Deakin University) (submittedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
  • Social Sciences › Education › Student Assessment and Feedback
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
Keywords
feedback in medical education, educational alliances, therapeutic relationship, supervisory relationship, feedback acceptance, psychotherapy theory
MeSH terms
Cooperative Behavior, Education, Medical, Feedback, Humans, Learning, Students, Medical, Thinking

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